Due to rising rates of anxiety, depression, and other mental health concerns in adolescents, TMS has been used off-label to treat depression in adolescents for many years. The U.S. Centers for Disease Control and Prevention (CDC) Youth Risk Behavior Survey Data Summary and Trends Report: 2013-20231 found that 40 percent of high school students reported persistent feelings of sadness or hopelessness, and 20 percent seriously considered report and highlight the scope of the problem. those who commit suicide, and nearly 10% have attempted suicide at least once. Although trends show gradual improvement, the problem remains significantly and dangerously underaddressed.
Mental health of US high school students
Source: Youth Risk Behavior Survey Data Summary and Trends Report: 2013-2023
Recently, the FDA approved the indication for use of TMS in adolescents 15 years and older using the NeuroStar TMS Treatment System (Neuronetics, Inc.), paving the way for broader application. The research that led the FDA to approve TMS for use in teenagers is discussed in more detail below, followed by an overview of what TMS is and how it works.
What is TMS?
Transcranial magnetic stimulation (TMS) is an FDA-approved therapy in 2008 for the treatment of major depressive disorder (MDD) in adults. Simply put, TMS works by stimulating different areas of the surface of the brain or cerebral cortex. TMS uses a changing, strong magnetic field, which stimulates neurons in the area beneath the magnetic coil. Like sound and light, magnetic fields become weaker the further away they are from their source, so TMS indirectly affects deep regions of the brain through connections with the cortex through the aptly named “cortical window.” . High-frequency TMS tends to increase brain activity, while low-frequency TMS tends to suppress it, and its effects are established over multiple treatment sessions over days to weeks.
Coil placement for depression treatment
Source: Neuronetics
Depending on the area being treated, TMS has different effects. For example, in MDD, TMS is typically applied to the left dorsolateral prefrontal cortex (DLPFC), whereas in obsessive-compulsive disorder (OCD), it is applied to the medial prefrontal cortex (MPFC). Recent posts referenced below discuss facilitation of TMS for depression (which can be administered over several days rather than weekly), TMS for OCD, positive results of polypharmacy of TMS and antidepressants, and indications for TMS in alcohol reduction. The emergence of external validity is addressed. craving. For example, standard TMS for MDD is 36 sessions once a day, and for OCD it is 29 sessions. Accelerated TMS uses a short treatment protocol called “intermittent theta burst stimulation” (iTBS) to deliver an equivalent number of sessions over a week.
TMS for teens
In a study recently published in the Journal of the American Academy of Child & Adolescent Psychiatry (2024), researchers looked at data from a large database of adolescents and young adults treated with TMS for MDD. was analyzed. They studied data from 1,283 patients aged 12 to 19 years and 601 patients aged 20 to 21 years who completed standardized measures of MDD (PHQ-9) and generalized anxiety disorder (GAD-7). We have considered the results. They examined the relationship between number of sessions and efficacy and improvement over the course of treatment in patients who completed at least 20 TMS sessions.
Of the total sample of 1,169 patients, 59.4 percent were found to meet criteria for remission (at least 50 percent reduction in symptoms) and 36.4 percent met criteria for complete remission. Efficacy was significantly higher with longer treatment duration. Improvement in anxiety was strongly correlated with improvement in depression. Treatment response rates mirrored those seen in the adult population, with an overall remission rate of approximately 35 percent across multiple antidepressant drug trials and 27.5 percent for first doses (Pigott et al. ., 2023) 3.
The researchers concluded:
This study investigated the largest sample to date of adolescents and young adults treated with TMS for MDD. TMS treatment significantly improved both depressive symptoms and anxiety in both adolescents and young adults. The magnitude of benefit, trajectory of symptom improvement, and dependence on number of treatment sessions indicated treatment effects similar to those seen in adults.
As a result of these results, the FDA has approved the indication for TMS treatment in adolescents 15 years and older4. Furthermore, TMS has obtained indication as a first-line adjunctive therapy given its favorable comparison with response to pharmacotherapy and remission rates.
Although TMS has been approved for the treatment of MDD and OCD in various age groups and has potential applications in other clinical conditions, TMS is probably underutilized because it is unfamiliar and difficult to access and cover. There remains no. For people suffering from partially treated or treatment-resistant mental illnesses, TMS is safe, well-tolerated, and offers a unique treatment option to consider.
